Experts see potential benefits to state, but Medi-Cal could still lose money

As a growing array of competing health care proposals emerged from the U.S. Senate on Thursday, there was plenty of bad news for millions of Californians.

But there were also a few rays of hope that may be good for their pocketbooks — including the prospect of more affordable 2018 health insurance premiums compared with the rest of the country.

The big picture, however, still isn’t pretty.

The latest version of the Republican leadership’s health care plan continues to cut $772 billion in funding over the next decade from Medicaid, the health care program for the poor that was expanded under the Affordable Care Act to include adults without dependent children — about 3.8 million people in California. All told, Medi- Cal, California’s version of Medicaid, is

expected to number about 14 million enrollees in the next year, or more than 1 in 3 Californians.

The revised Senate bill also continues to cut tax subsidies that have helped to lower the monthly insurance premiums for the overwhelming majority of the 1.4 million subsidized enrollees in Covered California, the state health insurance marketplace established under “Obamacare.”

And a proposed amendment by conservative Texas Sen. Ted Cruz would create two separate risk pools, one for healthy people with policies that provide barebones coverage and another for other people, including those with a prior history of illness.

They likely would be charged higher premiums because of their pre- existing conditions.

“Republicans spent the past two weeks putting lipstick on a pig,” California Sen. Dianne Feinstein said Thursday in a statement. “In all the ways that matter, the health care bill unveiled today is the same atrocious bill they couldn’t pass two weeks ago.”

While the outlook was described as devastating in the long term, two Bay Area health care policy experts advised Californians to take advantage of care and coverage options that will still be available in the short term.

Anthony Wright, executive director at Health Access California, said because California runs it own health care insurance exchange, it is able to invest and conduct its own marketing and enrollment programs. And because it has a bigger risk pool, Covered California can keep its premiums down.

By comparison, he said, those states that rely on the federally run insurance exchanges are at the mercy of the Trump administration and however aggressive it decides to market and enroll people in coverage.

Covered California is expected to announce its 2018 premiums by Aug. 1, and Wright believes Californians enrolled in the exchange will likely see much lower premium hikes than other states.

“I do think we have a better story than in other states,” Wright said.

Another piece of potentially good news comes from Larry Levitt, a vice president at the Menlo Park-based Kaiser Family Foundation, who pointed out that the Cruz amendment preserves state regulation of insurance.

So while the amendment could disrupt insurance markets nationwide, he said, “In California we would have the option of dialing that whole amend- ment back.”

Finally, a new plan introduced by Sens. Bill Cassidy, of Louisiana, and Lindsey Graham, of South Carolina, might work out in California, Levitt said.

As the two senators explained it Thursday, their proposal would keep much of the federal taxes in place and send that money to the states to control.

“If you like Obamacare, you can reimpose the mandates at the state level,” Graham told CNN Thursday. Or, he said, states could repair or replace Obamacare.

“It’ll be up to the governors,” Graham said. “They’ve got a better handle on it than any bureaucrat in Washington.”

Levitt said if the plan allowed California to preserve the current system that has led the state to successfully slash its uninsured by more than half, it could be attractive.

“But it depends a lot on the details,” Levitt said. “And there are no details.” Wright was equally wary. Without more information on the Cassidy- Graham proposal, he said, it’s too soon to evaluate its merits.

“If they are proposing to keep California” flush with Obamacare money, “that would be an assurance we don’t have today,” Wright said.